D M Rind

Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

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Publications (43)137.36 Total impact

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    ABSTRACT: Electronic clinical knowledge support systems have decreased barriers to answering clinical questions but there is little evidence as to whether they have an impact on health outcomes. We compared hospitals with online access to UpToDate with other acute care hospitals included in the Thomson 100 Top Hospitals Database (Thomson database). Metrics used in the Thomson database differentiate hospitals on a variety of performance dimensions such as quality and efficiency. Prespecified outcomes were risk-adjusted mortality, complications, the Agency of Healthcare Research and Quality Patient Safety Indicators, and hospital length of stay among Medicare beneficiaries. Linear regression models were developed that included adjustment for hospital region, teaching status, and discharge volume. Hospitals with access to UpToDate (n=424) were associated with significantly better performance than other hospitals in the Thomson database (n=3091) on risk-adjusted measures of patient safety (P=0.0163) and complications (P=0.0012) and had significantly shorter length of stay (by on average 0.167 days per discharge, 95% confidence interval 0.081-0.252 days, P<0.0001). All of these associations correlated significantly with how much UpToDate was used at each hospital. Mortality was not significantly different between UpToDate and non-UpToDate hospitals. The study was retrospective and observational and could not fully account for additional features at the included hospitals that may also have been associated with better health outcomes. An electronic clinical knowledge support system (UpToDate was associated with improved health outcomes and shorter length of stay among Medicare beneficiaries in acute care hospitals in the United States. Additional studies are needed to clarify whether use of UpToDate is a marker for the better performance, an independent cause of it, or a synergistic part of other quality improvement characteristics at better-performing hospitals.
    International Journal of Medical Informatics 06/2008; 77(11):745-53. · 2.06 Impact Factor
  • JAMIA. 01/2006; 13:91-95.
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    D Z Sands, D M Rind, C Safran
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    ABSTRACT: The Online Medical Record (OMR) is a full-featured shared electronic patient record in use since 1989 at Beth Israel Deaconess Medical Center in Boston. The first practice to use the OMR was a primary care practice. We observed the pattern of voluntary adoption of the OMR and the referral patterns from primary care to specialists. Adoption of the OMR among specialists has accelerated in recent years, in many cases mirroring the referral patterns from primary care to specialists. We hypothesize that referral of patients from primary care providers to specialists exposes these specialists to the benefits the electronic patient record and may promote the use of this technology. We conclude that these referral patterns provide a vector for the dissemination of electronic patient records. The important lesson is that EPR implementation in a health care network should begin with primary care to ensure the most efficient diffusion of this technology throughout the enterprise.
    Studies in health technology and informatics 02/2001; 84(Pt 1):685-9.
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    ABSTRACT: To determine rates of breast cancer screening for older women cared for in a primary care practice and to identify associations between patient and physician characteristics and breast cancer screening. A retrospective cohort study of older women. An urban hospital-based academic general medicine practice. This practice uses a computerized medical record and office procedures that facilitate tracking and ordering of mammograms. A random sample of 130 women aged 65 to 80 who receive primary care at a hospital-based general medicine practice. Data were collected from the hospital's computerized medical record. We recorded all clinical breast exams and mammograms performed or recommended during the 2-year study period. The median age of the 130 women studied was 71, and 21% of the women were black. Most patients had no serious comorbid illness (69%) and were independent in their activities of daily living (92%). During the 2-year study period, mammography was recommended for 95% of women and completed for 84%, and clinical breast exam was performed on 75%. Patients of male physicians had higher rates of mammography than patients of female physicians (89% vs. 75%, P = .045). Patients of faculty physicians had higher rates of clinical breast exam than patients of house officers or fellows (83% vs. 56%, P = .001). We report a very high rate of mammography for women cared for at a hospital-based primary care practice. The systems in place to facilitate ordering and tracking of mammograms probably contributed to the unusually high rate of mammography observed.
    Journal of the American Geriatrics Society 09/2000; 48(8):961-6. · 4.22 Impact Factor
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    C Safran, D Z Sands, D M Rind
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    ABSTRACT: The electronic patient record at the Beth Israel Deaconess Medical Center has fundamentally changed the practice of medicine in ways that its developers never foresaw. This type of highly interactive and work flow enabled program is creating new collaborative roles for computers in complex organizations [4]. With the system able to supervise and monitor care, computers are able to perform many care coordination and documentation functions, freeing people to concentrate more on interpersonal interactions and provision of health care services. One of the challenges in the design of electronic patient records to assist health care providers is how to support collaboration while not requiring that people meet face-to-face. Moreover, a greater challenge for each of us as clinicians is to use this technology as a bridge (rather than a barrier) towards better patient-doctor relationships.
    Methods of Information in Medicine 01/2000; 38(4-5):308-12. · 1.08 Impact Factor
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    ABSTRACT: Patient descriptors, or "problems," such as "brain metastases of melanoma" are an effective way for caregivers to describe patients. But most problems, e.g., "cubital tunnel syndrome" or "ulnar nerve compression," found in problem lists in an Electronic Medical Record (EMR) are not comparable computationally--in general, a computer cannot determine whether they describe the same or a related problem, or whether the user would have preferred "ulnar nerve compression syndrome." Metaphrase is a scalable, middleware component designed to be accessed from problem-manager applications in EMR systems. In response to caregivers' informal descriptors it suggests potentially equivalent, authoritative, and more formally comparable descriptors. Metaphrase contains a clinical subset of the 1997 UMLS Metathesaurus and some 10,000 "problems" from the Mayo Clinic and Harvard Beth Israel Hospital. Word and term completion, spelling correction, and semantic navigation, all combine to ease the burden of problem conceptualization, entry and formalization.
    Methods of Information in Medicine 12/1998; 37(4-5):373-83. · 1.08 Impact Factor
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    ABSTRACT: Since 1989, Beth Israel Hospital has been deploying an extensive online patient record (the OMR), which augmented a heavily used integrated hospital information system. Initially begun in a large primary care practice, the system is now used to share patient records among 36 practices on three campuses. Although the system was intended to eliminate the need for paper, we have found that it has, in the short term, increased the amount of paper produced. Elimination of paper record in ambulatory care has saved us $56,000, but we have yet to realize the savings of an additional $200,000 per year. We explore the factors that contribute to this "paper paradox" and discuss the costs associated with increased paper production, areas in which we have reduced paper handling, and strategies for reducing our reliance on paper.
    Studies in health technology and informatics 02/1998; 52 Pt 1:60-3.
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    ABSTRACT: Using cognitive evaluation techniques, this study examines the effects of an electronic patient record and electronic mail on the interactions of health care providers. We find that the least structured communication methods are also the most heavily used: face-to-face, telephone, and electronic mail. Positive benefits of electronically-mediated interactions include improving communication, collaboration, and access to information to support decision-making. Negative factors include the potential for overloading clinicians with unwanted or unnecessary communications.
    Artificial Intelligence in Medicine 02/1998; 12(2):137-151. · 1.36 Impact Factor
  • D M Rind, C Safran
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    ABSTRACT: We have proposed elsewhere a strategy for releasing medical records via the World Wide Web. The philosophical underpinnings of this proposal balanced a need for access with a need for confidentiality of medical information. Other balance points could have been chosen, and methods of stronger and weaker protection of confidentiality are presented here along with the rationale behind the selected strategy.
    Studies in health technology and informatics 02/1998; 52 Pt 2:1148-50.
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    ABSTRACT: This paper presents results from a demonstration project of nationwide exchange of health data for the home care of diabetic patients. A consortium of industry, academic, and health care partners has developed reusable middleware components integrated using the HOLON architecture. Engineering approaches for multi-organization systems development, lessons learned in developing layered object-oriented systems, security and confidentiality considerations, and functionality for nationwide telemedicine applications are discussed.
    Proceedings / AMIA ... Annual Symposium. AMIA Symposium 02/1998;
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    ABSTRACT: Using cognitive evaluation techniques, this study examines the effects of an electronic patient record and electronic mail on the interactions of health care providers. We find that the least structured communication methods are also the most heavily used: face-to-face, telephone, and electronic mail. Positive benefits of electronically-mediated interactions include improving communication, collaboration, and access to information to support decision-making. Negative factors include the potential for overloading clinicians with unwanted or unnecessary communications.
    Artificial Intelligence in Medicine 02/1998; 12(2):137-51. · 1.36 Impact Factor
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    ABSTRACT: The Boston Electronic Medical Record Collaborative is working to develop a system that will use the World Wide Web to transfer computer-based patient information to clinicians in emergency departments. Maintaining adequate confidentiality of these records while still facilitating patient care is paramount to this effort. This paper describes an explicit protocol that would make it possible to electronically identify patients and providers, secure permission for release of records, and track information that is transmitted. It is hoped that other, similar efforts now underway will be able to use and build on this model. Comment on this proposal is invited from all parties with an interest in confidentiality. The system will be used only with "scrubbed" data-data from which all identifiers have been removed-until it is generally agreed that the confidentiality methods proposed here are appropriate and sufficient.
    Annals of internal medicine 08/1997; 127(2):138-41. · 13.98 Impact Factor
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    ABSTRACT: In March of 1997, the National Research Council (NRC) of the National Academy of Sciences issued the report, "For the Record: Protecting Electronic Health Information." Concluding that the current practices at the majority of health care facilities in the United States are insufficient, the Council delineated both technical and organizational approaches to protecting electronic health information. The Beth Israel Deaconess Medical Center recently implemented a proof-of-concept, Web-based, cross-institutional medical record, CareWeb, which incorporates the NRC security and confidentiality recommendations. We report on our WWW implementation of the NRC recommendations and an initial evaluation of the balance between ease of use and confidentiality.
    Journal of the American Medical Informatics Association 01/1997; 4(6):458-64. · 3.57 Impact Factor
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  • J S Wald, D Rind
    New England Journal of Medicine 05/1996; 334(17):1139; author reply 1140. · 54.42 Impact Factor
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    ABSTRACT: W3-EMRS is an architecture designed to access clinical data from remote heterogeneous electronic medical record system (EMRS) databases. We describe the technologies used in an experimental implementation of W3-EMRS that concurrently collects data from several sources and presents them in an integrated set of views. After describing some of the organizational constraints, the architectural decision, implementation methodology, and operation of the completed project are discussed.
    Proceedings: a conference of the American Medical Informatics Association / ... AMIA Annual Fall Symposium. AMIA Fall Symposium 02/1996;

Publication Stats

743 Citations
137.36 Total Impact Points

Institutions

  • 1990–2008
    • Beth Israel Deaconess Medical Center
      • • Division of Clinical Informatics
      • • Division of General Medicine and Primary Care
      • • Department of Medicine
      Boston, Massachusetts, United States
  • 1997
    • Massachusetts Institute of Technology
      Cambridge, Massachusetts, United States
  • 1991–1996
    • Harvard Medical School
      • Department of Medicine
      Boston, Massachusetts, United States
    • Beth Israel Medical Center
      New York City, New York, United States